7. Diseases Of The Gallbladder And Bile Ducts Flashcards

1
Q

Chemical that stimulates gallbladder contraction.

A

CCK

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2
Q

This chemical mediates the relaxation of the sphincter of Oddi.

A

CCK

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3
Q

What does relaxation of the sphincter of Oddi allow?

A

Biliary and pancreatic secretions to enter the duodenum.

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4
Q

Composition of micelles of bile salts.

A

Cholesterol

Phospholipids

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5
Q

Main component of bile pigments

A

Bilirubin

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6
Q

Type of gallstone that is mostly calcium bilirubinate (black and brown).

A

Pigment (associated w/chronic infection or disease states w/ chronic hemolysis)

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7
Q

________secrete bile acids.

A

Hepatocytes

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8
Q

The 5 F’s: Risk factors for Cholelithisasis

A
Fat (BMI >30)
Female
Fertile
Forty >40
Fair
*Familial
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9
Q

Composition of biliary sludge

A

Cholesterol crystals
Calcium bilirubinate
Mucin gels

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10
Q

Presence of sludge means: (two things)

A

1) normal balance deranged

2) Nucleation

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11
Q

Stone and sludge in the gallbladder can cause these 3 main issues: (there are more)

A

1) Cholelithiasis-stones present, no sx
2) Acute cholecystitis- inflammation
3) Chronic cholecystitis-“great imitator”

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12
Q

This produces increased intraluminal pressure and distension of the gallbladder viscous that CANNOT be relieved by repeated biliary contractions.

A

Obstruction of the cystic duct OR CBD by stone

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13
Q

A patient presents with SEVERE pain in RUQ that radiates to right shoulder. Consider:

A

Biliary colic

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14
Q

Big factor that should make you suspicious of acute cholecystitis?

A

Long duration of pain (>5 hrs)

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15
Q

Precipitating factors for biliary colic:

A

Fatty meal
Meal after fasting
Any meals

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16
Q

When does biliary colic usually occur?

A

Nocturnal, w/in a few hrs of retiring

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17
Q

Arrest of inspiration on palpation of gallbladder.

A

Murphy’s sign

18
Q

First step in evaluation for gallbladder disease.

A

Ultrasound

19
Q

If ultrasound of gallbladder is inconclusive and patient is NOT acutely ill, what would be your next step?

A

HIDA scan

  • fast 4 hrs prior
  • evaluated bile-excreting function of liver and gallbladder EF
20
Q

If pt. is acutely ill with gallstones, what else would you test for?

A

CBC (leukocytosis?)

Hepatic panel

21
Q

_________% of people with asymptomatic gallstones will remain asymptomatic-25yrs.

A

60-80

22
Q

Gallbladder polyps occur in _____% of pop.

A

5

23
Q

A patient comes in for an ultrasound (not gallbladder related) and you find an 11mm polyp. She is 59 yrs old. What should you do?

A

Cholestystectomy

24
Q

A 49 yr old patient comes in for a routine RUQ ultrasound (not sure what for), she has no pain, fever etc. You find a 9mm polyp. What should you do?

A

Monitor

25
Q

A patient comes with SUDDEN RUQ pain, 101 fever, and leukocytosis. Consider:

A

Acute cholecystitis

26
Q

3 sources of inflammation of the gallbladder wall in acute cholecystitis.

A

1) Mechanical inflammation (distention)
2) Chemical inflammation (local tissue factors)
3) Bacterial inflammation (E. Coli, Strep etc)

27
Q

Acute inflammation of the gallbladder wall following obstruction of the cystic duct by a stone.

A

Acute cholecystitis

28
Q

Steps for acute cholecystitis work up.

A

1) Ultrasound!
2) Hepatic panel
3) CBC

*gen. Surg

29
Q

A pt. Comes in with no current pain, but said they recently had a “EXTREME bout of pain in the RUQ” a few days ago in the middle of the night. Next steps?

A

Ultrasound>Gen Surgery

*tell them to go to ER next time this happens

30
Q

What kind of drugs can induce sphincter of Oddi spasms?

A

Morphine-based

31
Q

If a patient with acute cholecystitis is in severe pain, high fever and leukocytes, what would you do?

A

1) Medically stabilize.
* NPO, IV FLUIDS, Fix electrolytes, NSAIDS, IV Antibiotics

2) Lap Cholecystitis

32
Q

Alternative to lap chol for extremely ill pt’s.

A

Percutaneous cholecystostomy tube (* gen surg decides)

33
Q

What would you use to evaluate for common bile duct stones during a lap chol?

A

Intraoperative cholangiogram (IOC)

34
Q

During a lap chol, what would you use to retrieve small CBD stones?

A

ERCP

35
Q

A post-cholecystectomy complains of severe diarrhea, what could give them?

A

Bile acid sequestration like Cholestyramine (Questran)

36
Q

A patient presents with severe abdominal pain, jaundice, and a high fever with chills. What is this triad of sx’s called and what might be happening?

A

Charcot’s triad

Bile Duct Leak

37
Q

How would you evaluate a build duct leak?

A

ERCP

*Stent CBD

38
Q

When gallstones pass into the CBD:

A

Choledocholithiasis

39
Q

When bile ducts are partially to completely obstructed and bacteria begins to climb the biliary tree into the liver:

A

CHOLANGITIS

40
Q

Type of cholangitis in which pus is under pressure in a completely obstructed ductal system.

A

Suppurative cholangitis

*Mortality rate approaches 100%

41
Q

Tx for cholangitis

A
Empiric antibiotics (IV)
ERCP or surgical drainage
42
Q

What drug would you use to dissolve cholesterol type stones?

A

Ursodeoxycholic acid (UCDA)